ABSTRACT
Structural barriers, such as provider resistance or unavailability of services, were rarely mentioned. Neither was lack of money often discussed except in the context of explanations for patient-dumping practices or in lobbying for government reimbursement. Now, in a period of fiscal crisis and cost control, the same higher morbidity rates and demands for more access through comprehensive national health insurance are met with a barrage of statements about the limits of medicine and the lack of appropriate health behavior. Several commentators now link overuse by the poor with their faulty health habits, and the latter are linked with ignorance. Again, education is seen as the solution; and again, the role of the providers or the insurance structure, in this case as promoters of utilization, is rarely mentioned. Previously, the poor were blamed for not using medical services enough, for relying too much on their own resources, and for undue suspicion of modern medicine. Now they are blamed for relying too much on admittedly ineffective medical services and not enough on their own resources.
